Individual
DR. KELLY HODSON UNKRICH
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
M.D.
Contact information
Practice address
807 CHILDRENS WAY, NEMOURS CHILDRENS CLINIC, JACKSONVILLE, JACKSONVILLE, FL 32207
(904) 697-3694
(302) 651-4945
Mailing address
PO BOX 191, PROVIDER ENROLLMENT DEPARTMENT, ROCKLAND, DE 19732-0191
(302) 651-6212
(302) 651-4945
Taxonomy
Speciality
Code
Description
License number
State
207W00000X
Ophthalmology Physician
37900
SC
207W00000X
Ophthalmology Physician
Primary
ME126470
FL
390200000X
Student in an Organized Health Care Education/Training Program
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
'017086000
—
FL
05
—
003177389A
—
GA
Enumeration date
05/16/2011
Last updated
12/08/2016
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